Gordon Brown’s first major speech on the National Health Service was spun to the media as a populist plea for health checks and screening programmes to be made widely available. In reality, it offered a reflective and wide ranging assessment of the state of the NHS in England in its 60th year and a broad indication of the future direction of reform.1 2In the process, the speech gave the clearest indication yet of the prime minister’s agenda for health policy.

At the heart of this agenda is the need for the benefits of medical advances to be made available in the NHS. In words that echoed Harold Wilson’s advocacy of the white heat of technology in the 1960s, Brown praised the progress already made through developments in clinical research, and welcomed the establishment of Europe’s largest medical science centre in London. He also indicated his willingness to accept increased concentration of services and hospital closures where there was evidence that this would deliver …